Association of intraoperative hypotension and acute kidney injury in noncardiac surgery patients: a post hoc secondary analysis of the EU HYPROTECT registry

Julian Runge¹, Carla D Grundmann¹, Carolina Mucha¹, Robin Denz², Karim Kouz³, Manuel Ignacio Monge García⁴, Elisabetta Cerutti⁵, Luciano Frassanito⁶, Michael Sander⁷, Simon J Davies^{8

9}, Abele Donati¹⁰, Javier Ripolles-Melchor^{11

12}, Daniel García-Lopez¹³, Benjamin Vojnar¹⁴, Etienne Gayat^{15

16}, Eric Nol¹⁷, Tim van den Boom¹⁸, Peter Bramlage¹⁹, Bernd Saugel³, Thomas W L Scheeren^{20

21}, Ulrich H Frey²²

Affiliations

¹ Department of Anaesthesiology, Operative Intensive Care Medicine, Pain and Palliative Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
² Department of Medical Informatics, Biometry and Epidemiology, Ruhr- University Bochum, Bochum, Germany.
³ Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Unidad de Cuidados Intensivos, Hospital Universitario de Puerto Real, Puerto Real, Spain.
⁵ Department of Anesthesia, Transplant and Surgical Intensive Care, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.
⁶ Department of Emergency, Intensive Care Medicine and Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
⁷ Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen, Giessen, Germany.
⁸ York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
⁹ Centre for Health and Population Sciences, Hull York Medical School, York, UK.
¹⁰ Department of Biomedical Sciences and Public Health, Universita Politecnica Delle Marche, Ancona, Italy.
¹¹ Department of Anesthesia, Hospital Universitario Infanta Leonor, Madrid, Spain.
¹² Universidad Complutense de Madrid, Madrid, Spain.
¹³ Department of Anaesthesiology and Reanimation, University Hospital Marques de Valdecilla, Santander, Spain.
¹⁴ Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany.
¹⁵ Université Paris Cité, INSERM, Paris, France.
¹⁶ Department of Anesthesia and Critical Care Medicine, Hopital Lariboisiere, Paris, France.
¹⁷ Department of Anesthesiology and Intensive Care, Hopital de Hautepierre, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
¹⁸ Edwards Lifesciences, Nyon, Switzerland.
¹⁹ Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
²⁰ BD Advanced Patient Monitoring, Heidelberg, Germany.
²¹ Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²² Department of Anaesthesiology, Operative Intensive Care Medicine, Pain and Palliative Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany. ulrich.frey@ruhr-uni-bochum.de.

PMID: 40676457
DOI: 10.1007/s10877-025-01329-4

Association of intraoperative hypotension and acute kidney injury in noncardiac surgery patients: a post hoc secondary analysis of the EU HYPROTECT registry

Julian Runge et al. J Clin Monit Comput. 2025.

. 2025 Jul 17.

doi: 10.1007/s10877-025-01329-4. Online ahead of print.

Authors

Affiliations

¹ Department of Anaesthesiology, Operative Intensive Care Medicine, Pain and Palliative Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
² Department of Medical Informatics, Biometry and Epidemiology, Ruhr- University Bochum, Bochum, Germany.
³ Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Unidad de Cuidados Intensivos, Hospital Universitario de Puerto Real, Puerto Real, Spain.
⁵ Department of Anesthesia, Transplant and Surgical Intensive Care, Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy.
⁶ Department of Emergency, Intensive Care Medicine and Anesthesia, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.
⁷ Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Giessen, Justus-Liebig University Giessen, Giessen, Germany.
⁸ York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
⁹ Centre for Health and Population Sciences, Hull York Medical School, York, UK.
¹⁰ Department of Biomedical Sciences and Public Health, Universita Politecnica Delle Marche, Ancona, Italy.
¹¹ Department of Anesthesia, Hospital Universitario Infanta Leonor, Madrid, Spain.
¹² Universidad Complutense de Madrid, Madrid, Spain.
¹³ Department of Anaesthesiology and Reanimation, University Hospital Marques de Valdecilla, Santander, Spain.
¹⁴ Department of Anaesthesiology and Intensive Care Medicine, University Hospital Marburg, Marburg, Germany.
¹⁵ Université Paris Cité, INSERM, Paris, France.
¹⁶ Department of Anesthesia and Critical Care Medicine, Hopital Lariboisiere, Paris, France.
¹⁷ Department of Anesthesiology and Intensive Care, Hopital de Hautepierre, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
¹⁸ Edwards Lifesciences, Nyon, Switzerland.
¹⁹ Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
²⁰ BD Advanced Patient Monitoring, Heidelberg, Germany.
²¹ Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²² Department of Anaesthesiology, Operative Intensive Care Medicine, Pain and Palliative Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany. ulrich.frey@ruhr-uni-bochum.de.

PMID: 40676457
DOI: 10.1007/s10877-025-01329-4

Abstract

Purpose: Previous cohort studies suggest that intraoperative hypotension is associated with acute kidney injury (AKI) in noncardiac surgical patients. We sought to ascertain that intraoperative hypotension is independently associated with AKI within the first 3 days after surgery in a contemporary cohort of noncardiac surgery patients in whom clinicians strove to avoid profound intraoperative hypotension.

Methods: This was a post hoc secondary analysis of the multicentre EU HYPROTECT registry, which includes patients undergoing major noncardiac surgery who underwent predictive blood pressure monitoring. The primary outcome of this secondary analysis was AKI within the first 3 days after surgery. To quantify the duration and severity of intraoperative hypotension we calculated the area under a mean arterial pressure (MAP) of 65 mmHg. We used logistic regression analysis to identify factors independently associated with AKI.

Results: We analysed 697 patients. 62 of these 697 patients (9%) developed AKI within the first 3 days after surgery. In multivariable binary logistic regression analysis adjusted for confounding variables, the area under a MAP of 65 mmHg was independently associated with AKI within the first 3 days after surgery (OR 1.03 [95% CI 1.01-1.05] per 10 mmHg*min; P < 0.001).

Conclusion: Our secondary analysis of the EU HYPROTECT registry shows that, in a contemporary population of noncardiac surgery patients in whom clinicians strove to avoid profound intraoperative hypotension, intraoperative hypotension is independently associated with AKI within the first 3 days after surgery.

Keywords: Blood pressure; Cardiovascular dynamics; Haemodynamic monitoring; Postoperative complications; Renal failure.

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Conflict of interest statement

Declarations. Competing interests: JR, CM, and RD declare to have no conflicts of interest.CDG is a consultant for and has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). KK is a consultant for and has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). KK is a consultant for Vygon (Aachen, Germany). MIMG has previously been employed by, is currently a consultant for, and has received honoraria for lectures from Edwards Lifesciences (Irvine, CA, USA). MIMG is a consultant for Dynocardia (Cambridge, MA, USA) and Deltex Medical (Chichester, UK). EC has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA) and MSD (Puteaux, France). LF is a consultant for and has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA).MS is a consultant for and has received institutional research funding for investigator-initiated trials and honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). MS has received honoraria for giving lectures from AMOMED (Vienna, Austria), Orion Pharma (Hamburg, Germany), and Philips Medizin Systeme Böblingen (Böblingen, Germany). SJD is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA).AD is a consultant for BIOVIIIx (Napoli, Italy) and Viatris (Milano, Itlay) and received honoraria for giving lectures from Edwards (Trezzano sul Naviglio Milano, Italy), Aspen (Verona, Italy), and Grifols (Vicopisano PI, Italy). JRM has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA), Baxter (Deerfield, IL, USA), and Fresenius Kabi (Bad Homburg, Germany). DGL has received honoraria for lectures from for giving lectures from Edwards Lifesciences (Irvine, CA, USA). BV is a consultant for and has received honoraria for lectures from for giving lectures from TEVA-ratiopharm (Ulm, Germany). BV has received honoraria for lectures from for giving lectures from Edwards Lifesciences (Irvine, CA, USA) and Vygon (Aachen, Germany). EG has received consultant fees from Baxter (Deerfield, IL, USA) and Mindray (Shenzhen, Chine) and research grants from Radiometer (Krefeld, Germany) and Philips (Böblingen, Germany). EN is a consultant for and has received research support from Edwards Lifesciences (Irvine, CA, USA) and is a consultant for MSD (Rahay, USA), Masimo (Neuchatel, Switzerland), Laboratoire Aguettant (Lyon, France), Pfizer (New York, USA), and Fisher & Paykel (Auckland, New-Zealand). TvdB has previously been employed by Edwards Lifesciences (Nyon, Switzerland).PB is a consultant for Edwards Lifesciences (Irvine, CA, USA), and his institution IPPMed received research funding for the organisation of the EU HYPROTECT registry. BS is a consultant for Edwards Lifesciences (Irvine, CA, USA), Philips North America (Cambridge, MA, USA), GE Healthcare (Chicago, IL, USA), Maquet Critical Care (Solna, Sweden), Pulsion Medical Systems (Feldkirchen, Germany), Vygon (Aachen, Germany), Retia Medical (Valhalla, NY, USA), Masimo (Neuchâtel, Switzerland), Dynocardia (Cambridge, MA, USA). BS has received institutional restricted research grants from Edwards Lifesciences, Baxter (Deerfield, IL, USA), GE Healthcare, CNSystems Medizintechnik (Graz, Austria), Pulsion Medical Systems, Vygon, Retia Medical, Osypka Medical (Berlin, Germany). BS has received honoraria for giving lectures from Edwards Lifesciences, Philips Medizin Systeme Böblingen (Böblingen, Germany), Baxter, GE Healthcare, CNSystems Medizintechnik, Getinge (Gothenburg, Sweden), Pulsion Medical Systems, Vygon, Masimo, Ratiopharm (Ulm, Germany). BS is an Editor of the British Journal of Anaesthesia.TWLS is an employee of BD Advanced Patient Monitoring (Heidelberg, Germany). UHF is a consultant for and has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA) and TEVA-ratiopharm (Ulm, Germany). He has received honoraria for giving lectures from CSL Behring (King of Prussia, PA, USA). Appendices: None.

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Association of intraoperative hypotension and acute kidney injury in noncardiac surgery patients: a post hoc secondary analysis of the EU HYPROTECT registry

Affiliations

Association of intraoperative hypotension and acute kidney injury in noncardiac surgery patients: a post hoc secondary analysis of the EU HYPROTECT registry

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources